Rad PQRS compliance outpacing other providers, though $100M in penalties loom

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Radiologists are nearly twice as likely as other providers to qualify for Medicare Physician Quality Reporting System (PQRS) bonuses, according to a study published online Jan. 8 in the Journal of the American College of Radiology.

The study, from the Harvey L. Neiman Health Policy Institute, found nearly 24 percent of eligible radiologists met PQRS requirements in 2010, compared with 16 percent for other providers.

Currently, those that meet PQRS requirement receive a .5 percent Medicare bonus payment, but in 2015, those bonuses will be replaced by penalties for those failing to meet thresholds, explained Richard Duszak, MD, CEO and senior research fellow of the Harvey L. Neiman Health Policy Institute, and colleagues. “Without improvements in the quality of physician documentation and practice reporting, more than 75 percent of radiologists could soon be penalized by Medicare. Collectively, these penalties are projected to exceed $100 million,” they wrote.

Medicare PQRS program data from 2007 through 2010 were analyzed for the study, with tiered scenario modeling used to project outcomes as the program transitions to handing out penalties.

Results showed that between 2007 and 2010, the number of incentive-qualifying radiologists increased each year, from 2,026 to 10,450. Mean 2010 incentive bonuses ranged from $2,811.39 for diagnostic radiologists to $12,704.38 for radiation oncologists. The authors also pointed out that radiologists using registry, rather than claims-based, PQRS reporting were 4.4 times more likely to qualify for incentive bonuses.

Duszak and colleagues noted that some early program participants were frustrated by contradictory program instructions and explanations from the Centers for Medicare and Medicaid Services (CMS). “Many physicians are skeptical that PQRS was implemented to improve quality of care and believe that the particular program measures chosen by CMS have little, if any, impact on real quality. Early reports by radiologists and non-radiologists alike have described operational frustration with PQRS and have suggested that its incremental administrative costs and requisite incremental physician work substantively offset the positive impact of incentive payments.”

The authors noted that CMS has made reporting requirements clearer, and automated reporting tools are now available to help achieve PQRS compliance.

“Our observation that only 23.7 percent of eligible radiologists qualified for bonus payments in 2010 may be met by many with disappointment, but it is balanced, we believe, by the fact that the number of incentive qualifying radiologists increased more than 5-fold over the program's first four years,” wrote the authors. They added that physician education, support from professional associations and relationships with registry vendors will be key to improving compliance going forward.